Fascia Myths and Fascia Facts

Have you noticed that the word “fascia” has become somewhat of a buzzword in the yoga world lately? There have been lots of articles written about this newly-appreciated bodily tissue (I myself have written two of them in the past few years!), and fascia has become a focus in many yoga classes - especially those that include rolling on self-massage tools like balls and foam rollers.

I understand this preoccupation with fascia, because it is a truly fascinating topic. Fascia is a type of connective tissue that forms a continuous body-wide web inside of us, surrounding and interpenetrating all of our muscles, bones, organs, nerves, and blood and lymph vessels. In fact, in addition to forming the architecture that weaves our inner structures together, our connective tissue system as a whole also absorbs and transmits force inside of us, working in conjunction with our muscular system to create smooth, efficient movement. Such insights have the power to expand the way we understand movement, which is very exciting!

In addition to these inherently interesting facts, there are other claims commonly made about fascia that are widely-believed, but reach a bit too far ahead of the research to be actually supported. Today I’d like to address a few of these specific claims in an attempt to encourage our yoga community to embrace a more science-based, productive dialog about the popular topic of fascia and the wonderful practices of massage and rolling.

 

MYTH #1: ROLLING ON BALLS AND OTHER MASSAGE TOOLS BREAKS DOWN FASCIAL ADHESIONS, KNOTS, AND SCAR TISSUE

Every massage therapist knows the experience of finding a tight spot in her client’s body, massaging it, and feeling it “release” or “relax” underneath her hands. It seems natural to assume that through her hands, she physically broke down a knot in her client’s fascia - and that through rolling on massage tools, we can do the same to ourselves too.

But one lesser-known fact about fascia is that its collagen fibers are literally as strong as steel. [Ref] To actually “break them up” would require so much force application that one’s body would sustain serious injury - this is not something that is achieved by a massage therapist’s hands or by a pair of massage balls.

Although you may feel a tight spot in your body change its texture after rolling or being massaged, this change was not due to the architecture of the fascia changing. For fascia to actually change its architecture, many, many inputs are required over a long time - collagen takes about three years in order to completely change and remodel. [Ref] Any instantaneous changes in tissue quality that you experience as the result of a massage are not the “breaking down” of adhesions, knots, or scar tissue - they are instead changes in tissue tone that are mediated by the nervous system. [Ref]

Once we understand that soft tissue treatments like massage and rolling work primarily via neurological communication instead of via physically breaking down adhesions, knots, and scar tissue, we might be encouraged to administer these treatments more gently than forcefully. When we roll and massage ourselves with deep, forceful pressure, this can often increase nervous system threat levels and sensitivity, which can be counterproductive to our efforts. Gentler, milder work is often more successful at decreasing threat levels and coaxing the nervous system to relax our tissues.

Massage and rolling on balls are undeniably wonderful, potent tools that help so many of us feel better in our bodies, but when we understand more about the mechanism for why they work, we will naturally be able to use them more wisely.

 

MYTH #2: WE FEEL PAIN IN OUR BODY BECAUSE OUR FASCIA IS FULL OF KNOTS, ADHESIONS, AND SCAR TISSUE

This is a very common belief, but it turns out that it is based on some inaccurate information about how pain works. I’ve written about the science of pain before [here and here], but one of the most foundational aspects of pain is that it is an output from the central nervous system, not an input from the periphery. It’s easy to be confused about this concept because when we feel pain, we feel it in a particular area of our body. It feels like the pain is in our tissues, and it’s our tissues that are therefore causing it. But the pain doesn’t actually reside in our tissues at all - it is 100% an experience that our nervous system has created for us to perceive - most likely to serve as some sort of protective signal.

Because pain is an output and not an input, adhesions, knots, and scar tissues - which are located in the periphery of our body (if they exist at all - but that’s a whole other topic!) - are not actually capable of creating pain. This concept might be tough to grasp, especially because we know that a massage therapist can touch a certain “knotty-feeling” spot on our body and it might feel tender or painful. But the pain you feel there was not created by the knot - it was created by your brain and experienced in that spot. Additionally, we know that we can have other painful-to-the-touch places in our body that do not actually correspond with a “knot” or tight spot that resides there. The flesh in those painful spots instead feels smooth and knot-free. And there are probably quite a few other locations in your body that definitely feel “knotty”-like when palpated, but are not associated with pain at all. [Ref]

As it turns out, pain and tissue quality are separate entities that sometimes overlap, but oftentimes do not. While it's easy to believe that all tight spots underneath our skin are problematic, the truth is that many of them are probably just normal, healthy variations in our tissue texture. And pain, regardless of where it is felt in the body, has less to do with knots, adhesions, and scar tissue, and more to do with a nervous system that has been sensitized around a particular area. This is a helpful, progressive change in perspective because the less that we pathologize the physical feel of "tightness" and "knottiness" in our tissues, the less likely we are to create nocebos for ourselves or our yoga students and massage clients. (A nocebo is a negative expectation of an otherwise harmless event or action that causes negative consequences like pain.)

 

MYTH #3: OUR FASCIA CAN BECOME DEHYDRATED AND ROLLING ON MASSAGE TOOLS HELPS TO RE-HYDRATE IT

This is an absolutely appealing and intuitive idea, but to the best of my knowledge, we don’t have research that supports this claim. Part of the problem lies in a lack of specificity for how this proposed dehydration/rehydration process would work.

An artist's depiction of connective tissue.

An artist's depiction of connective tissue.

In simple terms, our connective tissue is made up of cells, collagen fibers, and a non-living gelatinous matrix called ground substance. When the claim is made that fascia can be dehydrated, I believe the notion is that its ground substance is dehydrated.

It’s unclear to me how it could be determined that someone’s ground substance is dehydrated, however - can you tell by looking at someone from the outside? Maybe by looking at their skin? Can you tell because they feel pain somewhere? (As we mentioned earlier, pain and tissue quality are poorly correlated.)

Even if there was a reliable way to assess fascial dehydration, it is unclear to me how a massage or rolling on balls or other tools would hydrate it. The ground substance of connective tissue definitely has some water content, but how would the pressure from rolling change this water content? (Water that you drink goes through different channels in your body than water in your ground substance, so that's a different type of hydration than fascial hydration.) Does rolling add new water to fascia (how?), or does it move already-existing water from another part of the body to the deydrated one? If rolling did increase water content, wouldn’t everyone’s glutes be extra hydrated and especially healthy because so many of us squash them with pressure by sitting on them for hours every day?

Most of us believe this hydration claim because we heard it from someone knowledgeable like a smart yoga instructor or an experienced bodywork teacher. But if we actually look to connective tissue biology for some factual basis to the claim, we find that there is little support there. It may be true that massage can hydrate our dehydrated fascia, but research has not yet demonstrated this in a clear way. I believe we would do more of a service to our yoga community by waiting to make claims like this until science begins to produce some solid evidence for them.

 

In summary, fascia is an incredibly fascinating tissue of the body for an abundance of reasons. But we will better serve ourselves and our students if we shed some of our language about fascia that implies that it is full of painful adhesions and scar tissue that need to be broken down and hydrated. Additionally, massage therapy and self-massage tools like balls and foam rollers are absolutely wonderful, helpful practices that offer great results for so many people. But when we recognize and teach an awareness of the often-overlooked role that the nervous system plays in many of these massage benefits, we will be able to utilize these tools even more powerfully for ourselves and our students and clients.

 

(If you're interested in exploring these ideas further, you might appreciate this video from Quinn Henoch, Doctor of Physical Therapy:)

[Updated] A Brief Primer on Fascia and Why It's Cool

**Update November 2015: When I wrote this article, it was based on the best information I had at the time, but I have learned more about the actual science of connective tissue (of which fascia is one component) since that time, and much of what I have learned makes a lot of what I wrote in this piece quite outdated. In this article I wrote that fascia was "aware" and "communicating constantly with your brain". It would be more accurate to say that fascia is an insensate tissue which houses our peripheral nerves, and that those nerves are what do the actual communicating with the brain.

I also wrote that one's fascia can become unhealthy, dried out, and brittle, and that we should use tools like self-massage balls to re-hydrate it, keep it supple, and heal its restrictions. This is what I had learned about fascia then (and it's still pretty much the dominant paradigm today), but I now believe that claims like these are not supported by the evidence.

Pain is complex and it's hard to truly pinpoint why we might experience pain in our body in the first place (unless it's acute pain from a recent injury). We also can't actually know what tissues we're affecting underneath our skin when we give or receive massage. Even though we might *feel* like our fascia is being hydrated or our fascial restrictions are being "broken up", there is no real way to know that because there are many layers of tissue in the body and the only tissue that we physically touch through massage is our skin.

Additionally, there is no known mechanism for how rolling on balls could actually physically re-hydrate our tissues (if they are even de-hydrated to begin with, which also seems physiologically implausible). The relationship between water and our fascia simply doesn't work like that inside our body.

The science is also strongly suggesting that we can't truly manipulate and change our fascia on a structural level through massage anyway, or at least through one single massage session - any actual change to the connective tissue must be the result of many, many repeated inputs over a long time. Yes, people can absolutely feel better after rolling or a massage, but the reason *why* they feel better is not because their fascia was changed.

I absolutely think that massage is a wonderful tool that can help people alleviate pain, but I don't think it necessarily works for the structural, tissue-based reasons that the current explanatory model claims. Instead, any reduction in pain that we experience after a massage is most likely due to a change in nervous system output - which is an entirely different system of the body than the connective tissue system. (The nervous system is amazing!)

One more point I'd like to make is that if we believe that our fascia becomes unhealthy and dehydrated inside of us, and if we believe that rolling on balls or receiving massage from a massage therapist helps "heal" our fascia, which then results in a healthier, better-functioning body, then we can begin to treat and approach rolling and massage as essential tools for health. We can easily start to believe that if we don't use these tools (or if our yoga students or clients don't use these tools) that we are doomed to a dehydrated body that doesn't function well and is prone to pain. I find this to be an inaccurate, structurally-based view of the body that can also encourage us to overlook other more effective means for actually improving our connective tissue's health, like movement and exercise.

Let's learn about our connective tissue and our fascia because it helps us to understand and embody our body better, and let's utilize rolling and massage because they are awesome tools, but let's not inflate their importance and relevance to keeping our bodies healthy. Rolling and massage doesn't "treat" our fascia. We're not better off because we roll on balls or foam rollers or receive massage and we're not worse-off if we don't - these are just some tools among the plethora of tools and practices available to help us embody our body better and possibly reduce pain.

In any case, I just wanted to add this commentary here for the record and as a helpful example of how one's perspective can change over time based on new information. Thanks so much for reading! ///

 

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Hi Everybody! Many of you have been asking about the 2-day course with fascial anatomy researcher Robert Schleip that I attended the other week in Culver City, and I thought I’d write up a summary of some of the most interesting things I learned about fascia to share with you. These insights are combined with some of the posture/alignment studies I’ve been doing over the past year with amazing biomechanist Katy Bowman. Have fun reading this write-up, and feel free to let me know if you have any questions (you can comment here on the blog or email or FB me) and I’ll do my best to answer them for you!
 

Previously thought to be nothing more than an inconsequential “space-filler” inside of us, fascia (pronounced “FAH-sha”) is only recently being appreciated by science for the major, big-picture role that it plays in our long-term health and well-being. The newest research on fascia tells us that is a multi-layered, body-wide web of connective tissue that is literally everywhere inside of us. It surrounds and suspends all of our “parts” (bones, muscles, organs, nerves, blood and lymph vessels) together into one cohesive, completely-connected fascial network that utilizes tensional forces to keep everything happy and in its proper place. This means that no one “part” of us is really separate from any other, and what happens in one localized area (tension, injury, healing massage, etc.) directly affects our body as a whole.

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And one of the coolest things about fascia (especially for yogis) is that it is so much more than just an intricate tensional support system for your body (although that in and of itself is enough to make fascia seriously rad!) Fascia is also extremely “alive” and “aware” inside of you, communicating constantly with your brain. We’re all familiar with the human body’s 5 senses of sight, smell, touch, taste, and sound, each of which are informed by their own specialized sensory receptors in the eyes, nose, skin, etc. Fascinatingly, fascia is said to house the sensory receptors for our very real “sixth sense”. We’re not talking ESP, telepathy, or crystal balls here :) - our “sixth sense” is our body’s ability to sense its position in space, otherwise known as proprioception. While proprioception may sound like an unfamiliar word and a potentially unexciting sense, it is actually an extremely important element of our daily functioning - without it, we wouldn’t be able to walk or move ourselves through space in a coordinated way, and we would instead exist as a helpless heap on the floor (saaad!)
 

Nearly all of us have enough connection to our proprioception to “get by” in life, but some people have a higher level of proprioception than others. As yogis, we all want to inhabit, feel, and be present inside our bodies, and it is proprioception via the gateway of our fascia that provides this for us. If our fascia is healthy and hydrated, we will truly embody our body to the fullest extent - we’ll move and walk through our life with the grace of a cat or that ninja I like to reference in class sometimes :), and most importantly, our body will thrive rather than degenerate as we age.

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But here’s the deal. Fascia isn’t necessarily 100% healthy in all of us - in fact, almost everyone who lives in this modern life has at least some unhealthy fascia, which we experience as tightness, “aches and pains”, injury, and if left long enough (like for years), results in joint degeneration, osteoarthritis, cardio-vascular disease, and more. ***Big important point right here (don’t miss it!): The immobility, stiffness, and chronic pain that most of us chalk up to as “the natural process of aging” is actually just our fascia that has become dried out, brittle, and inflexible. We can actually age quite beautifully and gracefully in our bodies, maintaining a high level of mobility and the ability to take care of ourselves, if we simply keep our fascia supple and hydrated.
 

And if your fascia is already on the dried-out side, which you would know if you have any stiffness in your body at all (hamstrings, anyone?), just know that this is completely reversible - you aren’t “stuck” with a body that will continue to stiffen and immobilize as you age. But bringing your fascia back to health and your body back to suppleness will take real dedication and time - Robert Schleip says that it takes fascia anywhere from 6 months to 2 years to fully remodel itself in response to your efforts. Our unhealthy, stiff fascia is the result of our own posture and body-use habits over a lifetime, so it takes time to un-do the effects those patterns have had.  There is no quick-fix to healing your fascial restrictions, but the steps you take toward this end, starting now :), will be so worth it in the big picture!

So how do we keep our fascia hydrated?

Unfortunately, drinking water won’t do the trick. While drinking water will definitely hydrate your already-healthy fascia, it is sadly unable to make its way to your unhealthy fascia. The only ways to hydrate dried-out fascia are whole body movementstretching, and massage. The dried-out tissues basically just need to be moved and manipulated to bring circulation, flow, and lymph (that’s your waste-removal system - super important!) back to the area.
 

But this is easier said than done. None of the "exercise" that we usually think of (running, biking, swimming, etc.) qualifies as whole-body movement because we use only some of our muscles to move only a few of our joints in repetitive ways during these activities, rather than utilizing our whole body. Even the amazing practice of yoga, which offers us so many benefits, doesn’t target the body in a whole-body way. We use some muscles more than others in the practice and stretch certain areas, but not others. As awesome as it is, yoga isn’t a neuromyofascially- (to use the anatomical term!) balanced practice. (Although in my class, I do my best to teach and sequence in a way that is as balanced as I can manage with the best of my knowledge - even though that means that some of what we do might not be so “traditional”. I’m not really concerned with tradition as much as with our long-term health and wellness, which is why I teach the way that I do.) Additionally, yoga tends to focus on stretching and strengthening, but there is no “massage” to our tissues that happens in the practice.

-the magic balls (heh heh...)

-the magic balls (heh heh...)

This is the whole reason that I started my new Total Alignment Reset class. In this class, we use magic massage balls to give ourselves deep tissue massage to relieve the chronic tension patterns that we carry in our body, as well as to hydrate our stiff, dried-out fascia, so that we can live healthier and happier in our bodies. It’s really the perfect complement to your yoga practice or to any other activity you do. The work we do in Total Alignment Reset is meant as awesome self-care and “pre-hab” - so that we can reset our out-of-balance tissues BEFORE they get injured and we then need “re-hab”. (Get it? Heh hehhhh.) If I had my way, you would all take this class once a week to balance out your yoga practice, to keep your muscles and fascia healthy, and to live in your body in a more embodied way (read: proprioception! The coolest word you might have learned today!)

-my fascia-hydrating class at Yoga Soup: Thursday evenings 6:45-7:45 and only $12! (click to enlarge flyer)-

Anyway, there’s lots more to say about fascia and the body, but I’ll save it for another write-up for you guys. In the meantime, feel free again to ask me if you have any questions, and I'm so happy that you're interested in learning more about the body so you can live better inside of it!